Patient Selection For Fontan Operation

Ten characteristics were identified which would permit a good outcome after the Fontan operation.
Whimsically, these were called the TEN COMMANDMENTS of the Fontan procedure.

The ten commandments included data which could be obtained before surgery by examining the
patient, and carrying out tests like echocardiography and cardiac catheterization. When more of the
ten commandments are "obeyed", the better are the chances of a happy result from surgery.

What are the ten criteria ?

Here is a list of the ten criteria:

Age above 4 years

No distortion of lung arteries from prior shunt surgery

Normal venous drainage

Normal ventricular function

Adequate pulmonary artery size

No atrio-ventricular valve leak

Low pulmonary artery pressure (below 15 mmHg)

Low lung blood vessel resistance

Normal heart rhythm

Normal right atrial size

What do these criteria mean ?

In effect, all these criteria were to ensure that the resistance of blood vessels in the lung was not too
high. A high resistance would interfere with passive lung blood flow. This could be produced by
very small pulmonary arteries, blood vessel wall thickening and hardening, mitral valve leak or
reduced function of the left ventricle. In all of these conditions, a Fontan operation would not be
performed, or modified to reduce the risks.

What are the kinds of Fontan-type operations ?

Ever since its first description, the Fontan operation has been modified many times. Each
modification aimed to avoid one of the drawbacks of the previous types. While some are definitely
better, others are not very different. We are still striving to devise the "best" type of Fontan repair
for each group or individual.

As I mentioned earlier, in the original Fontan operation, the venous blood was diverted to the lungs
directly from the right atrium, and the ASD was closed. While Dr.Fontan used an artificial valve
between the inferior vena cava (IVC) and the right atrium, future modifications eliminated this.

The aims of the "ideal" Fontan operation are

To achieve a smooth stream-lined blood flow from veins to the lungs

To retain growth potential as the child becomes older

To avoid use of artificial materials

To be adaptable to patients of any age group

To learn about the most frequently performed TCPC Fontan (Total Cavo-Pulmonary Connection),
read the next article on this site.

Material on this site is provided for informational purposes only. It is not meant to be a substitute for professional medical advice. The information should not be used to diagnose or treat a health problem, disease, or to prescribe any medication. In case of doubt, promptly contact your health care provider.